中文版暴力风险量表在住院精神疾病病人中的应用

[目的]探讨中文版暴力风险量表在住院精神疾病病人中的应用效果。[方法]观察组(2013年7月1日—12月31日入院)病人采用中文版Brset暴力核查清单(BVC)进行暴力风险评估,根据评分值采取相应的干预措施,并与2012年同期入院的对照组病人暴力攻击行为发生情况、约束情况、病人家属满意度进行比较。[结果]两组病人入院8周内暴力攻击行为发生率、约束率、约束时间、病人家属满意度比较,差异均有统计学意义(P0.05)。[结论]BVC评估精神疾病病人的暴力风险简便、准确,提高了暴力应急处理的预见性,降低了暴力攻击行为的发生率及约束率,提高了病人家属满意度,对规范及完善暴力风险的管理程序具有积极意义。     

中文版暴力风险量表对精神病病人暴力行为预测能力的研究

[目的]比较中文版Broset暴力核查清单（BVC）和暴力风险筛查量表（V-RISK-10）对住院精神病病人暴力行为的最佳切分值及短期预测能力.[方法]引入、修订BVC和V-RISK-10量表,对118例住院精神病病人在入院时进行评估,连续观察1周,以期间出现暴力言行（含言语、徒手和采用物体攻击）和暴力行为（含徒手和采用物体攻击）为阳性结果,比较BVC和V-RISK-10不同切分值的ROC曲线下面积（area under the curve,AUC）、灵敏度、特异度和阳性预测率（PPV）.以最大AUC值确定最佳切分值.[结果]暴力言行和暴力行为的最佳切分值在BVC均为2/6分,V-RISK-10分别为9/20和10/20;暴力言行和暴力行为的阳性预测率在BVC分别为93.75％和76.56％;在V-RISK-10分别为77.03％和70.49％.[结论]精神病病人住院第1周内,BVC和VRISK-10对其暴力言行和暴力行为均有较好的预测能力,且BVC的预测能力优于V-RISK-10.     

中文版暴力风险量表对精神病病人暴力行为预测能力的研究

[目的]比较中文版BrΦset暴力核查清单(BVC)和暴力风险筛查量表(V-RISK-10)对住院精神病病人暴力行为的最佳切分值及短期预测能力。[方法]引入、修订BVC和V-RISK-10量表,对118例住院精神病病人在入院时进行评估,连续观察1周,以期间出现暴力言行(含言语、徒手和采用物体攻击)和暴力行为(含徒手和采用物体攻击)为阳性结果,比较BVC和V-RISK-10不同切分值的ROC曲线下面积(area under the curve,AUC)、灵敏度、特异度和阳性预测率(PPV)。以最大AUC值确定最佳切分值。[结果]暴力言行和暴力行为的最佳切分值在BVC均为2/6分,V-RISK-10分别为9/20和10/20;暴力言行和暴力行为的阳性预测率在BVC分别为93.75%和76.56%;在V-RISK-10分别为77.03%和70.49%。[结论]精神病病人住院第1周内,BVC和V-RISK-10对其暴力言行和暴力行为均有较好的预测能力,且BVC的预测能力优于V-RISK-10。     

暴力风险评估表在住院精神疾病患者中的应用研究

目的探讨暴力风险评估表在住院精神疾病患者中的应用效果。方法对临床护士进行暴力风险评估表应用方法、技巧和管理的培训,然后在临床中应用暴力风险评估表;比较暴力风险评估表使用前、后1年的暴力事件的发生率。结果使用暴力风险评估表后,暴力事件发生率低于使用前(χ~2=175.011,P<0.001)。结论使用暴力风险评估表,可以筛选出高危患者,并及时给予早期干预,有效减少暴力事件的发生。     

客体关系量表在精神疾病鉴别诊断中的应用

目的：探讨不同精神疾病的客体关系特点，为临床中精神疾病的鉴别诊断提供帮助。方法：应用客体关系自主同一性量表（MOA）测量符合入组标准的32例正常成人、32例分裂症（偏执型）病人、30例抑郁症（单相）病人及31例躁狂症病人客体关系水平。结果：采用三分法,各组在高客体关系水平及低客体关系水平差异显著，在中客体关系水平上无显著性差异。采用MOA七因子区分各种精神疾病，显示在分离自主的相互作用（SI）、分离自主的相似活动（SA）、依赖活动（DA）、毁灭性不平衡（DI）等变量上各组之间均存在显著差异。DI可能作为区分正常人与精神病人的一个指标。结论:在不同客体关系水平上,不同精神疾病客体关系各有特点，部分客体关系变量在精神疾病鉴别上有一定的意义。     

疼痛评估量表在癌症疼痛病人中的应用

[目的]探讨疼痛评估量表在癌症疼痛病人中的应用.[方法]对152例癌症疼痛病人采用数字分级法(NRS)与修订版面部表情法(FPS-R)进行疼痛评估与临床监控.[结果]首次评估NRS评分平均5.6分,经规范化止痛治疗后,疼痛完全缓解92例,部分缓解48例,未缓解12例.[结论]疼痛评估量表能直观、动态地反映病人疼痛变化过程、疼痛部位及性质,同时对疼痛的治疗和护理干预具有很好的指导作用.     

疼痛评估量表在癌症疼痛病人中的应用

[目的]探讨疼痛评估量表在癌症疼痛病人中的应用。[方法]对152例癌症疼痛病人采用数字分级法（NRS）与修订版面部表情法（FPS-R）进行疼痛评估与临床监控。[结果]首次评估NRS评分平均5.6分,经规范化止痛治疗后,疼痛完全缓解92例,部分缓解48例,未缓解12例。[结论]疼痛评估量表能直观、动态地反映病人疼痛变化过程、疼痛部位及性质,同时对疼痛的治疗和护理干预具有很好的指导作用。     

中文版吞咽功能评估量表评估脑卒中患者吞咽障碍的可行性分析

目的探讨中文版吞咽功能评估量表(GUSS)评价脑卒中患者吞咽障碍的临床可行性。方法选取2013年9月~2014年9月本院住院部收治的60例脑卒中患者,依次进行GUSS筛查及洼田饮水试验,观察两种试验结果的相关性,并依次比较不同吞咽功能表现患者的GUSS评分结果。结果本组患者GUSS筛查检出率为61.7%,高于饮水试验,差异具有统计学意义(P0.05);无吞咽障碍患者的GUSS评分为(20.0±0.0)分高于吞咽障碍患者,差异具有统计学意义(P0.05)。结论针对脑卒中患者采用GUSS筛查可准确评估其吞咽功能,对吞咽障碍的早期发现与干预均具有重要指导价值。     

代币制在住院精神疾病患者行为干预中的作用研究

目的　验证代币制疗法对于精神疾病患者行为干预中的作用。方法　在对精神疾病患者和家属问卷调查及访谈的基础上 ,对研究组 80例住院精神疾病患者进行代币制治疗 ,运用护士观察量表、阴性与阳性症状量表、自知力与治疗态度问卷作为评定工具进行评价 ,同时与对照组 78例住院精神疾病患者进行比较。结果　研究组经代币制治疗 1个疗程后的病情总估计均分、总积极均分、社会兴趣因子、个人整洁因子高于对照组 ,而总消极均分、迟缓因子、抑郁因子、阴性量表均分、复合量表均分和攻击量表均分低于对照组 ,差异具显著性或亟显著性意义 (P <0 .0 5 ,P <0 .0 1 )。结论　代币制疗法对改善住院精神疾病患者的阴性症状、提高患者的社会兴趣和负性情绪具积极的影响 ,有利于降低精神残疾程度 ,提高社会生活能力 ,其效果的持续性需进一步研究     

Perceiving risk in dangerous situations: risks of violence among mental health inpatients

BACKGROUND: Violence in British psychiatric hospitals appears to be escalating, with nursing staff the most frequent victims of assault. There is also public concern about violence on the part of individuals with mental health problems. In this climate, assessing a patient's risk of violent behaviour has become an important part of mental health care. However, little research has been published into how mental health nurses undertake such assessments in their day-to-day clinical practice. AIM: The study focused on how mental health nurses make assessments of risk in clinical crisis situations where there is a perceived likelihood of imminent violence. The study sought to identify skills, cognitive processes or any other mechanisms which nurses draw upon to assist in such assessments. METHOD: Ten experienced mental health nurses working in a secure mental health environment were interviewed and data generated was analysed using a grounded theory approach. An in-depth literature search was also undertaken. FINDINGS: It was found that, in their risk assessments, nurses rely extensively on their personal knowledge of their patients (in particular, previous history of violent behaviour; biographical data; and impact of the mental health problem on violent behaviour). Nurses 'tune in' to potentially violent situations by observing a scenario as a whole, as well as specific aspects of a patient's behaviour, whilst also searching for causes of the violent behaviour. In making clinical risk assessments, nurses often make rapid, intuitive judgements in which various possibilities are considered regarding the likelihood of violent behaviour (such as the capacity and capability of a patient to be violent and the potential in the situation). It was also found that the ability to intervene successfully in potentially violent situations reduced the level of risk that nurses felt exposed to, and here nurses draw on their knowledge of a particular patient. They also perceive lower levels of risk when working in a skilled team. CONCLUSION: The study indicates that the development of nurse-patient relationships and working in a supportive team are perceived as protective factors against risk. Implications of the research are discussed in relation to nurse-patient relationships, particularly in the context of the current nursing climate and the way in which violent behaviour may lead to an erosion of these relationships. The importance of 'working in a team' is discussed, as is the consequence of the findings for education and development. Methodological limitations of the study are also discussed.     

心理干预对重性精神疾病患者肇事肇祸危险度的影响

目的：探讨心理干预对社区重性精神疾病患者肇事肇祸危险度的影响。方法对603例社区重性精神疾病患者进行肇事肇祸危险度评估,并在常规治疗的基础上于随访时进行社区心理干预,观察1a。干预后再次评定患者的肇事肇祸危险度,并与干预前进行对比分析。结果心理干预后入组患者的肇事肇祸等级构成有显著变化（P＜0．05）,其中精神分裂症患者和初中及以上文化程度患者的肇事肇祸危险等级显著降低（P＜0．01）,精神发育迟滞患者和小学及以下文化程度患者的肇事肇祸危险等级无明显变化（P＞0．05）。结论心理干预能显著降低社区重性精神疾病患者的肇事肇祸危险度,但对精神发育迟滞患者及文化程度低的患者效果不明显。     

Assessing and managing risk of violence in the mentally disordered

This review paper explored the concepts of risk assessment and management in relation to 'serious' violence by individuals with mental disorder. The paper highlighted the political context in which concern over serious violence by those with mental disorder is increasing. Government guidance on risk assessment was considered and identified as having an actuarial bias. Correlational studies, which provide actuarial indicators of risk, were explored and a picture was developed that demonstrated the difficulty of determining risk of violence to others simply on the basis of psychiatric symptomatology. The literature led to a conclusion that risk assessment for violence is an inexact science, and that actuarial indicators need to be supported by structured thorough clinical investigation. Legal concerns around the assessment and management of risk were also explored. The Health and Safety Executive model for risk management was explored in relation to the findings of the risk-assessment literature and the recommendations of reports into serious violent incidents. The model was shown to have potential utility in providing a legally sound framework for the assessment and management of risk of violence in mental disorder.     

Empowerment in people with a mental illness: reliability and validity of the Swedish version of an empowerment scale

Empowerment has become a widespread concept in various social policy contexts referring to different marginalized groups. Empowerment has also been focused within the mental health field although little empirical research exists. The aim of the present study was to investigate internal consistency and construct validity of the Swedish version of an empowerment scale developed for people with a mental illness, Making Decisions. Ninety-two persons were subject to an interview also comprising assessments of quality of life, needs for care, psychiatric symptoms, psychosocial functioning, aspects of the social network, rejection experiences and attitudes of devaluation/discrimination towards people with mental illness. The results showed that the overall scale and the subscales had a good internal consistency, except for the subscale power–powerlessness. A factor analysis revealed two superordinate factors, self-esteem and activism and community and power, with a satisfactory internal consistency. These two factors showed a good construct validity with expected associations to validation measures. Stigma was most markedly associated with self-esteem and activism, and a higher level of education was most strongly associated with community and power. In conclusion, the Swedish version Making Decisions may well be used in further studies of empowerment among people with a mental illness.     

ABO血型在精神病患者中的分布及早期干预作用

目的探讨ABO血型与精神病的发病率有无关系,比较各类精神病患者与血型有无关系,找出不同血型与精神病患者发病相关性,为精神病的早期干预提供可行性参考。方法对2004年1月至2007年5月在本院住院且符合《中国精神疾病分类方案与诊断标准》患者603例,采用长春博德生物技术有限公司的血型试剂正定型法测血型。结果（1）603例患者中A型患者198例,B型患者155例,O型患者199例,AB型患者51例,与汉族人血型比较,A型：31．31％;B型：28．06％;AB型：9．77％;O型：30．86％,差异无统计学意义（P〉0．05）。（2）在不同类型精神病患者中各种血型的分布差异有统计学意义（P〈0．05）。结论ABO血型在精神病患者中的分布比例与汉族健康人群血型的分布比例并无明显差异,在各种具体精神病分类中ABO血型的分布存在一定差异。     

Reliability and validity of the Japanese version of the Self‐Identified Stage of Recovery for people with long term mental illness

The Self‐Identified Stage of Recovery (SISR) is a two‐part scale assessing both the stage of recovery (SISR‐A) and the component processes of recovery (SISR‐B) for people with mental illness. This study aimed to develop a Japanese version of the SISR and to examine its reliability and validity. The Japanese versions of the SISR‐A and SISR‐B were developed through focus group cognitive interviews and the translation–back translation procedure. A cross‐sectional questionnaire survey was conducted of 223 participants who had long term mental illness, were aged 20 years or older, and currently living in communities and inpatient ward settings; 59.2% were males and the average age was 47.6 years. The questionnaire also included the 24‐item Recovery Assessment Scale, Herth Hope Index, Empowerment Scale, and Resilience Scale. Cronbach's alpha coefficient, intraclass correlation coefficient, and weighted kappas were generally fair to high, and the SISR‐A and SISR‐B scores were positively correlated with other relevant scales. This study supported the reliability and validity of the Japanese versions of the SISR‐A and SISR‐B among people with long term mental illness in Japan.